The Influence of Gender on Symptom Characteristics During Acute Coronary Syndrome

摘要 预计将有140多万美国人经历急性 冠状动脉综合征（ACS）2010年对ACS症状的评估很重要 因为症状决定了患者何时或是否寻求护理。最近的研究 确定了ACS症状的性别差异，然而回顾性设计， 从病历中提取症状，以及评估表的变化 难以确定性别差异的临床意义，或者 需要具体的健康信息。因此，本前瞻性研究的目的是 是：1）评估性别差异的发生，严重程度和痛苦的13 校正年龄、诊断、合并症和功能状态后的ACS症状，2） 建立敏感性，特异性和症状的预测值作为指标， 女性和男性ACS，3）探索症状群，包括 性别、年龄、诊断、合并症和功能状态，以及4）确定是否存在 是功能的纵向（30天和6个月）结果的性别差异 状态、主要心血管事件、入院情况、急诊就诊情况， and mortality.一个探索性的目的是确定是否存在的关系， 选择ACS的女性和男性的生物标志物和症状。一种新的方法，在 当症状发生时，急诊室会记录哪些症状， 被利用样本将由630名急诊入院的患者组成 症状提示ACS的科室：522例确诊ACS的患者， 108例患者排除ACS。参与者将从四个医疗中心招募， 伊利诺斯州和俄勒冈州。13项ACS症状检查表将于 介绍给急诊科。合并症、活动状态和患者 将在患者稳定时测量变量。试点数据显示， 程序是可行和安全的。协方差分析将用于检验 假设症状存在性别差异。症状群将是 使用凝聚聚类分析进行检查，并对患者结局进行评价 使用线性混合方法。研究结果将有助于建立临床意义， ACS症状

Abstract More than 1.4 million Americans are expected to experience an episode of acute coronary syndromes (ACS) in 2010. Evaluation of the symptoms of ACS is important since symptoms determine when, or if, patients seek care. Recent studies have identified gender differences in symptoms of ACS, however retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of gender differences or if gender specific health messages are warranted. Therefore, the aims of this prospective study are to: 1) evaluate for gender differences in the occurrence, severity, and distress of 13 ACS symptoms after adjusting for age, diagnosis, comorbidities, and functional status, 2) establish the sensitivity, specificity, and predictive value of symptoms as an indicator of ACS for women and men, 3) explore symptom clusters including characteristics of gender, age, diagnosis, comorbidities, and functional status, and 4) determine if there are gender differences in the longitudinal (30 days and 6 months) outcomes of functional status, major cardiovascular events, hospital admissions, emergency department visits, and mortality. An exploratory aim is to determine if a relationship exists between selected biomarkers and symptoms of ACS for women and men. A novel approach, in which symptoms are recorded in the emergency department as they are occurring, will be used. The sample will be comprised of 630 patients admitted to the emergency department with symptoms suggestive of ACS: 522 patients with confirmed ACS and 108 patients ruled out for ACS. Participants will be recruited from four medical centers in Illinois and Oregon. The 13-item ACS Symptom Checklist will be completed on presentation to the emergency department. Comorbidities, activity status, and patient variables will be measured when the patient is stable. Pilot data indicate that the procedures are feasible and safe. Analysis of covariance will be used to test the hypothesis that there are gender differences in symptoms. Symptom clusters will be examined using agglomerative cluster analysis, and patient outcomes will be evaluated using linear mixed methods. Findings will aid in establishing the clinical significance of ACS symptoms.